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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 384004110
Report Date: 08/28/2024
Date Signed: 08/28/2024 11:33:09 AM

Substantiated


STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
SAN BRUNO CC RO, 851 TRAEGER AVE., SUITE 360
SAN BRUNO, CA 94066
This is an official report of an unannounced visit/investigation of a complaint received in our office on
07/23/2024 and conducted by Evaluator Luis Gomez
PUBLIC
COMPLAINT CONTROL NUMBER: 05-CC-20240723085606
FACILITY NAME:CREATIVE GARDENSFACILITY NUMBER:
384004110
ADMINISTRATOR:LAU, AGNESFACILITY TYPE:
850
ADDRESS:1429 VALENCIA STREETTELEPHONE:
(415) 577-8389
CITY:SAN FRANCISCOSTATE: CAZIP CODE:
94110
CAPACITY:56CENSUS: 35DATE:
08/28/2024
UNANNOUNCEDTIME BEGAN:
09:00 AM
MET WITH:Agnes Lau, Nina JohnsonTIME COMPLETED:
11:00 AM
ALLEGATION(S):
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Unqualified staff left alone with children
INVESTIGATION FINDINGS:
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On 8/28/2024 at 9:00AM., Licensing Program Analyst (LPA), Luis Gomez met with Program Coordinator, Nina Johnson. Program Director, Agnes Lau arrived during inspection. The purpose of today's inspection was explained and was for an unannounced complaint investigation. Present was the program coordinator and 8 staff supervising for 35 children. Facility was inspected for health and safety hazards.

During inspection, LPA performed observation, interviewed staff, and reviewed facility records. At 10:30AM., Based on record review and interview, LPA confirmed proof of teacher qualifications (S1) missing from facility files. Deficiency cited on attached case management report (LIC809).

As part of this investigation, observations were conducted on 8/1/2024 and 8/28/2024. LPA completed review of the facility records, which included sign-in sheets, personnel files, and the parent handbook. LPA conducted interviews with program director, staff, and guardians. (REFER TO 809C FOR CONT.)
Substantiated
Estimated Days of Completion:
SUPERVISORS NAME: Marie Rodriguez
LICENSING EVALUATOR NAME: Luis Gomez
LICENSING EVALUATOR SIGNATURE:

DATE: 08/28/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/28/2024
This report must be available at Child Care and Group Home facilities for public review for 3 years.
LIC9099 (FAS) - (06/04)
Page: 1 of 3
Control Number 05-CC-20240723085606
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
SAN BRUNO CC RO, 851 TRAEGER AVE., SUITE 360
SAN BRUNO, CA 94066
FACILITY NAME: CREATIVE GARDENS
FACILITY NUMBER: 384004110
VISIT DATE: 08/28/2024
NARRATIVE
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(Page 2)
Regarding the allegation of unqualified staff left alone with children; Based on evidence collected, LPA determine allegation made is valid. During inspection, LPA observed children in toddler classroom, left without supervision of a qualified teacher during outside play.

Based on information obtained the preponderance of evidence standard has been met, therefore the allegation is found to be SUBSTANTIATED. California Code of Regulations (Title 22, Section 12 Chapter 1) is being cited on attached 9099D.

This report will be kept in the Facility File and will be made available for Public Review upon request. Website for Forms and Regulations: www.ccld.ca.gov. This report and appeal rights were discussed with licensee

LPA unable to print report during inspection. Copy of report will be sent to program director at a later date.

SUPERVISORS NAME: Marie Rodriguez
LICENSING EVALUATOR NAME: Luis Gomez
LICENSING EVALUATOR SIGNATURE:

DATE: 08/28/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/28/2024
LIC9099 (FAS) - (06/04)
Page: 2 of 3
Control Number 05-CC-20240723085606
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
SAN BRUNO CC RO, 851 TRAEGER AVE., SUITE 360
SAN BRUNO, CA 94066

FACILITY NAME: CREATIVE GARDENS
FACILITY NUMBER: 384004110
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 08/28/2024
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
09/05/2024
Section Cited
CCR
101229(a)(1)
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101229(a)(1) Responsibility for Providing Care and Supervision. (1) No child(ren) shall be left without the supervision of a teacher at any time, except as specified in Sections 101216.2(e)(1) and 101230(c)(1).

This requirement was not met as evidenced by:
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Director will submit updated staff roster (LIC500), ensuring qualifed teachers are assigned to all classrooms (P1, P2, T1) duirng the hours of operation (7:30AM- 6:00PM) by due date: 9/5/2024.
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During inspection, LPA observed children were left without supervision of a qualified teacher. This poses a potential health and safety risk to children in care.
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Proof of correction will be submitted to the Department via email.
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Failure to correct the cited deficiency(ies), on or before the Plan of Correction (POC) due date, may result in a civil penalty assessment.
SUPERVISORS NAME: Marie Rodriguez
LICENSING EVALUATOR NAME: Luis Gomez
LICENSING EVALUATOR SIGNATURE:

DATE: 08/28/2024
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/28/2024
LIC9099 (FAS) - (06/04)
Page: 3 of 3